a. Field of the Invention
The instant invention relates to the field of payment systems, and in particular to payment systems for maximizing collections, compliance and peace of mind.
b. Description of Related Art
Traditionally, there have been two major types of software used by providers' offices—billing software and electronic medical records software (EMR). Billing Software helps providers submit their charges to Health Insurance Plans/Payers and collect the insurance-portion-due. EMR systems enable providers to document their decision-making, treatment and prescriptions, for example, in electronic form. Billing Software has at least one deficiency in that there is no software that is able to facilitate payment from the patient of the patient-portion-due, the so called “self-pay component”.
For the past several years, the Federal Government has been releasing specifications for paving the Health Care Information Superhighway. For an example of this, see www.hitsp.org. Additionally, major companies and governmental entities everywhere are combining forces to develop the organizational pillars of the Superhighway, based on the HITSP specifications, known as the Regional Health Information Organizations (RHIOs). RHIOs may be thought of as massive federated databases of health information which are able to easily “talk to each other.” With this in mind, EMR has been seen as a necessary component to RHIO evolution due to the simple fact that EMR is how health care providers interact with the database.
The relevancy today of EMR and Billing Software is no longer the applications per se, but the data captured and transferred by those applications. There has also been a lot of discussion about health care records being owned by the patient. However, real “ownership” of the records will ultimately come in the form of the 10 cents per page stakeholders will pay each time they want copies of those records or to gain access to those records. In other words, what is really driving the private industry involvement in the Health Care Information Superhighway is an entirely new, realizable form of intangible property, namely access to the underlying data.
The Superhighway specifications at this juncture deal with medical data, such as lab work, prescriptions and medical encounters, for example. However, research indicates that the scope of the Superhighway will keep increasing, spiraling out to any form of data that touches or affects the health care system. It is expected that the Superhighway will further encompass reimbursement related data.
Not surprisingly, the Superhighway is unfolding in the form of multiple federated databases, as opposed to following a more centralized model. When it comes to federated systems, four major areas of concern appear to include: (1) data aggregation, (2) normalization, (3) federation, and (4) reconciliation. The migration of health care technology towards federated databases, and more particularly the need for data aggregation and normalization, seem to translate into the requirement(s) subscribers need to amass accurate, non-redundant data.
With this in mind, it has been found that in the healthcare industry, for example, there is a large problem of uncollected care. Major trends in the health care industry are affecting the ability of health care providers to get paid, grow their practices and minimize risk. Insurance deductibles are increasing. Coverage is declining. Benefits are becoming more complex. These and other trends are resulting in increased subject responsibility both directly and indirectly. For example, indirectly, the trends are having the effect of increasing subject responsibility by “clouding” the line between the insurance- and self-pay-portion. The net effect of these and other factor that would be evident to those possessing an ordinary skill in the art is increases in the amount of uncollected care.
By way of specific example, in 2006, uncollected care reached $3.9 Billion in the chiropractic industry. During this time, the chiropractic industry in the United States included approximately 30,000 chiropractic firms totaling approximately 40,000 actively practicing chiropractors with total revenues of $7 billion. During the same year, total chiropractic charges reached $10.9 billion, placing uncollected care at an estimated $3.9 billion or approximately 35% of the revenue.
While the discussion above centered in the chiropractic industry, this industry is not the only market that is experiencing uncollected costs—for example, the back pain industry is estimated at $44 billion annually with as much as $24.5 billion in uncollected care.
Therefore, a need exists to enable industries to collect uncollected costs. Further a need exists to present a solution that contains core components as separate, stand-alone system. The present invention provides such a method and system.